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Fetal Endoscopic Tracheal Occlusion (FETO)

Fetal Endoscopic Tracheal Occlusion (FETO)

For select patients with moderate to severe CDH, Texas Children’s Fetal Center offers fetal endoscopic tracheal occlusion (FETO), a breakthrough surgery with the potential to dramatically improve lung growth before birth.

FETO is a minimally invasive procedure in which a tiny balloon is inserted into the fetus’ trachea. The balloon is then inflated to block the trachea, then left in place for several weeks to allow the fetus’ lungs to grow, and removed a few weeks before delivery. If the lungs can be made to grow before the baby is born, it gives the child a head start by providing sufficient lung capacity at birth.

Texas Children’s Fetal Center is one of the few programs in the nation that has received permission from the U.S. Food and Drug Administration for the moderate TOTAL trial, a pilot study of fetal endoscopic tracheal occlusion (FETO) for moderate cases of congenital diaphragmatic hernia (CDH). Learn about the inclusion criteria for the TOTAL trial.

Learn more about this pioneering surgery: 

About the procedure

Texas Children’s comprehensive approach to CDH begins with the first prenatal visit, continues through delivery and the postnatal period, and into adolescence and early adulthood.

Mothers considering fetal tracheal occlusion (FETO) should be examined in the Fetal Center as early as possible after diagnosis of CDH, preferably between 22 and 26 weeks gestation. Amniocentesis, ultrasound and fetal echocardiogram will be conducted.

 is provided by a multidisciplinary team that includes some of the nation’s top maternal-fetal medicine specialists, surgeons, neonatologists, cardiologists and pulmonologists, among others.

The procedure is performed in the hospital between 26 and 28 weeks gestation. The mother and fetus are sedated, and the mother is given medication to help prevent labor.

A tiny incision is made in the mother’s abdomen and uterus. Then, guided by ultrasound, the surgeon inserts a trocar (tube about the size of a straw) through which an endoscope (tiny tube with a camera at the tip) is placed into the fetal trachea. The balloon is then introduced and inflated.

Why choose Texas Children’s Fetal Center to repair your baby’s CDH?

We are one of the oldest and most experienced programs in the nation, with a history of leading the development and implementation of innovative therapies and procedures, such as FETO. We are pioneers in finding cutting-edge, evidence-based programs that give new options to patients with CDH.

Learn more about the TOTAL trial, a pioneering surgical option for babies with moderate CDH.


As with any surgical intervention, FETO has risks. These include:

  • Preterm labor
  • Loss of pregnancy
  • 30% risk of membrane rupture

Your doctor will discuss these with you and help you decide if the benefits outweigh the possible problems.

Volumes & Outcomes

Our outcomes in FETO and CDH repair are among the best in the country.

To read the most recent study showing outcomes of FETO for fetuses with severe cases of CDH, please reference this medical article:

After the Procedure

After surgery, the mother will have weekly ultrasounds and will be closely monitored at the Fetal Center. She will need to remain in Houston, no more than 30 minutes from the hospital, until the balloon is removed or deflated. The balloon blocks the baby’s airway, and it is critical that the mother is able to get to the hospital quickly if the need arises. Every family will meet with our social worker who will assist with concerns regarding their stay in Houston. After several weeks, the mother will be scheduled for a second procedure to remove or deflate the balloon. This procedure does not increase the risk for cesarean section.

Please call toll-free 1-877-338-2579 if you would like to discuss a specific case or diagnosis with a physician from Texas Children’s Fetal Center.